WHO says SARS outbreak is over, but fight should go on

Editor-With the possibility of SARS returning before the arrival of
an effective vaccine or anti-viral agent, there is a need to evaluate the
treatment for SARS. Official figures showed that of the 5326 probable
cases in China, 3104 had been treated with traditional Chinese medicine
(TCM)[1]. Was TCM useful? Reports of clinical studies from Beijing,
Guangzhou and Tianjin have recently been presented in conferences. One of
these studies was a prospective, controlled trial, involving over 500
patients in 11 hospitals. Consensus from these studies suggested that,
compared with Western medicine treatment alone, the addition of TCM
treatment could help to reduce fatality rate, improve oxygen saturation in
critically ill patients, and alleviate symptoms such as dyspnea[2]. The
TCM treatment typically consisted of a dozen or so medicinal substances,
mostly herbs. It was prescribed based on the pattern classification theory
of TCM, directed to counteract the signs and symptoms associated with each
stage of SARS. Most of the ingredients, such as herba houttuyniae, flos
lonicerae and radix scutellariae, are in fact commonly used for relieving
symptoms associated with viral or bacterial infections of the upper
respiratory tract.

TCM has a history of 3000 years in treating infectious diseases, and
detailed documentation of treatment protocols can be found in many Chinese
medical classics. The medicinal substances used are diverse, with
properties such as anti-viral, anti-bacterial, anti-inflammatory, anti-
pyretic or immunomodulatory. As natural substances they share one common
advantage: they have been used on human for thousands of years without
significant long term side effects. Maybe for this reason, tens of
millions of people in China took TCM produces as a preventative measure
during the SARS epidemic[3]. In contrast, the combination of ribavirin and
steroid, which was the core of the Western medical treatment protocol,
remains highly controversial because of their known side effects[4]. We
have seen many post-SARS patients in Hong Kong left with symptoms of
fatigue, dyspnea, insomnia, sweating, hair loss, amenorrhea and even mood
disturbance. Although it is still not clear to what extent these symptoms
are associated with damage by the organism(s) causing SARS, it is almost
certain that some of them are iatrogenic. If the next SARS epidemic does
eventuate, are we going to repeat the same combination, or will we try
other unproven drugs? Perhaps it is time to learn more about the
integration of TCM and Western medical treatment, as suggested by the WHO
team at their visit to the Guangdong Provincial TCM Hospital in China this
April.

References:

1.Takungpao (A Chinese News Paper in Hong Kong), A16, 17-07-2003.

2.Prevention and treatment of SARS with TCM. Proceeding of a conference
organized by the State Administration of TCM on 01-07-2003.

3.Chan M. Beijing imposes Sars-related price controls. South China Morning
Post, 18-04-2003.

4.Cyranoski D. Critics slam treatment for SARS as effective and perhaps
dangerous. Nature, 423(6935):4, 2003.

Competing interests:  
None declared